Abstract

ABSTRACT:

INTRODUCTION: Manganese regulates many enzymes and is essential for normal development and body function. Chronic manganese intoxication has an insidious and progressive course and usually starts with complaints of headache, fatigue, sleep disturbances, irritability and emotional instability.

Later, several organ systems may be affected and, due to neurotoxicity, an atypical parkinsonian syndrome may emerge. With regard to neuropsychiatry, an array of symptoms may develop up to 30 years after intoxication, of which gait and speech abnormalities, cognitive and motor slowing, mood changes and hallucinations are the most common. Psychotic phenomena are rarely reported.

CASE PRESENTATION: We describe the case of a 49-year-old Caucasian man working as a welder who was referred to our facility for evaluation of acute paranoid psychotic behavior. Our patient’s medical history made no mention of any somatic complaints or psychiatric symptoms, and he had been involved in a professional career as a metalworker. On magnetic resonance imaging scanning of his brain, a bilateral hyperdensity of the globus pallidus, suggestive for manganese intoxication, was found. His manganese serum level was 52 to 97nmol/L (range: 7 to 20nmol/L).

A diagnosis of organic psychotic disorder due to manganese overexposure was made. His psychotic symptoms disappeared within two weeks of treatment with low-dose risperidone. At three months later, serum manganese was decreased to slightly elevated levels and the magnetic resonance imaging T1 signal intensity was reduced. No signs of Parkinsonism were found and a definite diagnosis of manganese-induced apathy syndrome was made.

CONCLUSION: Although neuropsychiatric and neurological symptoms caused by (chronic) manganese exposure have been reported frequently in the past, in the present day the disorder is rarely diagnosed.

In this report we stress that manganese intoxication can still occur, in our case in a confined-space welder, and may present clinically with a paranoid psychotic state that necessitates a rapid diagnostic procedure in order to avoid the permanent structural brain damage that may occur with chronic exposure.

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Our special colleague on this journey is Dr. Eric Kandel. He is a psychiatrist and neuroscientist and professor at Columbia University. He’s also affiliated with the Howard Hughes Medical Institute.
He received the Nobel Prize in physiology or medicine in 2000 for his research into the biological mechanisms of learning and memory. ”
These videos are also available from the charlie rose website directly: http://www.charlierose.com/view/collection/10702

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WARNING: The risks associated with suddenly stopping medicines cannot be overstated. Stopping psychiatric medication without medical supervision and review can be very dangerous. This site is for informational purposes only and is not intended as a substitute for advice from your physician or other healthcare professional. You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment.

If you or a loved one have experienced a manic or psychotic episode and you suspect a misdiagnosis of a "mental disorder", try to find a healthcare provider who uses Functional Medicine and will test for underlying conditions. Your insurance may pay for the tests and treatments. Also consult a malpractice attorney.